=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518375039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 4FRONT HEALTHCARE OF ATLANTA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2014
-----------------------------------------------------
Last Update Date | 05/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 PEACHTREE ST NW SUITE 2360
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-480-4136
-----------------------------------------------------
Fax | 404-480-4137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 PEACHTREE ST NW SUITE 2360
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-313-8983
-----------------------------------------------------
Fax | 404-480-4137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | GEORGE SLAUGTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-313-9935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------